Neurological and Cognitive-Perceptual Approaches Flashcards Preview

COTA Neurological Disorders and Intervention Approaches > Neurological and Cognitive-Perceptual Approaches > Flashcards

Flashcards in Neurological and Cognitive-Perceptual Approaches Deck (53):
1

Contemporary Task-Oriented Approaches to Motor Control

Reject assumptions of reflex-hierarchical model of motor control and traditional neuro theories

Movement is controlled by the integration and interaction of multiple systems (enviroment, sensorimotor, musculoskeletal, behavioral/emotional goals)

Includes motor learning principles

Believes continued practice of compensatory methods limits functional recovery

2

Stages of Motor Learning

1. Skill Acquisition/Cognitive stage

2. Skill Retention/Associated stage

3. Skill Transfer/Autonomous stage

3

Cognitive Stage
of Motor Learning

Develops an understanding of task.

Strategies
Highlight purpose of task
Demo ideal performance of task
Have pt verbalize task components/requirements
Select appropriate feedback- (high dependence on vision; focus on errors as they become consistent; focus on success of movement outcome)
Learner self-eval (id problems/solutions)
Organize initial practice
Assess, modify arousal lvls
Structure environment

4

Associated Stage
of Motor Learning

Learner practices movements, refines motor program
Dependence on visual feedback decreases; proprioceptive feedback increases

Strategies
Select appropriate feedback- continue to focus on consistent errors and success of outcome; assist learner with self-eval and decision-making
Organize feedback schedule
Organize practice- encourage consistency of performance
Structure environment

5

Autonomous Stage
of Motor Learning

Learner practices movements; continues to refine motor responses; movements are largely error-free

Strategies
Assesses need for conscious attention, automaticity of movements
Select appropriated feedback- occasional feedback when errors are evident
Organize practice- high lvls of practice are appropriate
Structure enviroment
Focus on competitive aspects of skills as appropriate

6

Motor Learning Practice

Random practice- practice of several tasks that are presented in a random order, encouraging reformulation of the solution to the presented motor problem

Blocked practice- repeated performance of the same motor skill

Variable conditions- practice of skills in various contexts to improve transfer of learning and retention

Mental practice- cognitive rehearsal of a skill w/o actually moving

7

NDT Treatment

Inhibit abnormal patterns of movement and posture via handling, positioning, use of key points of control

Goal is to replace the abnormal movement patterns with normal patterns of movement. Secondary result will be more normal sensory input to reinforce the normal movement patterns

8

PNF Approach

Stimulation of the proprioceptors (in the joints)
Use of reflexes to stimulate normal movement
Focus is on correcting imbalances between the antagonists
Facilitate stronger muscles to stimulate the weaker ones
Use of sensory cues to facilitate normal motor movement (touch, vision, auditory)
Use of diagonal and circular patterns of movement to reinforce normal patterns of movement

9

Brunnstorm Approach

there is belief to use whatever the patient may have.

Sees the use of synergies as being ok and if used over and over then ultimately they get integrated into more normal patterns of movement

10

Rood Approach

Felt sensory stimulation assisted with the development of normal muscle tone and motor responses

Treatment uses a lot of vibration, stroking, slow rolling from side to side, brushing, rubbing, followed by a functional motor movement

11

Assessment of Glenohumeral Joint Subluxation

Allow pt's arm to dangle into gravity

Palpate the space underneath the acromion process w/index finger

Compare to intact side and document width of space in terms of finger breadths

12

Direct Intervention (Bolus)
Oral Motor Dysfunction

Mod if consistency, amount, and pacing of solids and liquids

Postural interventions to increase swallowing efficiency during meals (chin tuck, head tilt, head turn)

Specific swallowing adaptions

13

Indirect Intervention (No Bolus)
Oral Motor Dysfunction

Thermal (cold) stimulation via chilled dental examination mirror to elicit a swallow reflex

Reflex facilitation

Strengthening, facilitation, and coordination of oral movements

Airway adduction procedures

Positioning

14

Goals of Orthotic/Splinting Interventions for Neuromotor Dysfunction

Prevent/correct deformity

Control spasticity by aligning joints and providing stretch

Position hand in functional posture

Compensate for weakness

Support painful joint

Promote distal joint mobility

Immobilize to promote healing

Prevent/reduce scarring

15

Types of Inhibitory/Tone Normalizing Orthoses

Bobath finger spreader- soft splint positions digits/thumb in abd to reduce tone

Rood cone- reduce flexor spasticity in hand

Orthokinetic splints- utilizes tactile input to facilitate and/or inhibit muscle groups

Spasticity reduction splint- places the spastic distal extremity on submaximal stretch to reduce spasticity

16

Cock-up Splint

Supports the wrist in 10-20* of ext to prevent contracture

Allows digits to function

17

Ayres Sensory Integration Approach

Assumes:
Neuroplasticity of the CNS allows for its modifications

Sensory integration occurs in a developmental sequential manner

18

Tactile Modulation for Tactile Defensiveness; Hypo/Hypersensitivity; Sensory Seeking

Self-applied more tolerable than passive application

Apply controlled sensory activities that simultaneously provide tactile and vestibular-proprioceptive info

Begin w/slow linear movements and deep touch-pressure (visible)

Apply tactile stimuli in the direction of hair growth

Follow tactile stimuli w/joint compression

Monitor and adjust stimuli

Assess the child's behavioral responses

19

Tactile Discrimination Intervention

Provide deep-touch pressure to the hands/body

Tx for tactile discrimination is usually performed simultaneously when providing tx for deficits in motor planning

Provide graded activities req tactile discrimination activities using a mix of textures/items (rice,sand)

20

Proprioception Intervention

Deficits in modulation demonstrated by hypersensitivity and sensory seeking

Provide firm touch, pressure, joint compression, or traction

Provide resistance to active movement to help child learn approp amount of force to perform tasks

Provide actv in various positions combining vestibular proprioceptive info (yoga)

Provide slow linear movement, resistance, deep pressure

Use adaptive techniques (weighted vest)

21

Vestibular Interventions

Deficits in modulation include hyposensitivity, hypersensitivity, sensory seeking, and gravitational insecurity

Grade for type and rate of movement, and for amount of resistance

Slowly intro linear movement w/touch pressure in prone and provide resistance to active movements

Use linear vestibular stimuli to increase awareness of spatial orientation

Provide rapid rotary and angular movements w/freq starts/stops and acceleration/deceleration to increase ability to distinguish the pace of movement (semicircular canals)

22

Astereognosis

Also know as tactile agnosia

inability to recognize objects, forms, shapes, and sizes by touch alone

23

Types of Apraxia

Ideomotor: unable to complete activity at will

Ideational: inability to comprehend the concept of movement or execute the act automatically or in response to a command

Constructional: deficit in the ability to copy, draw, or construct a design.

24

Brocca's Aphasia

Frontal Lobe

expressive aphasia

Can range from the mildest type with intact comprehension and the ability to communicate through writing to a complete loss of speaking out loud.

25

Wernicke's Aphasia

Temporal

receptive aphasia

26

Somatoagnosia

diminished awareness of body structure and a failure to recognize one's body parts

27

Anosognosia

an unawareness of motor deficit

28

Perserveration

continuation/repetition of motor act or task

29

Acalculia

inability to perform calculations

30

Alexia

inability to read

31

Agraphia

inability to write

32

Anomia

loss of ability to name objects or retrieve names of ppl

33

Dysmetria

udershooting (hypometria) or overshooting (hyepermetria) of a target

34

Dyssynergia

a breakdown in movement resulting in joints being moved separately as opposed to smooth movement

35

Dysdiadochokinesia

impaired ability to perform rapid alternating movements

36

Ataxia

loss of motor control or coordination of voluntary movement

37

Akinesia

inability to initiate movement

38

Athetosis

writhing movement

39

Dystonia

involuntary muscle group contractions that cause repetitive or twisting movements

40

Chorea

involuntary movements of face and extermities

41

Choreoathetosis

involuntary movements in a combination of chorea (irregular migrating contractions) and athetosis (twisting and writhing).

42

Hemiballismus

thrashing movements of extremities

43

Impaired Alertness Intervention

Increase environmental stimuli

Use gross motor activities

Increase sensory stimuli

44

Motor/Ideomotor Apraxia Intervention

Utilize general verbal cues as opposes to specific

Decrease manipulation demands

Provide hand/hand input

Utilize visual cues

45

Ideational Apraxia Intervention

Provide step-by-step instructions

Use hand/hand input

Provide opportunities for motor planning/execution

46

Perseveration Intervention

Bring perserveration to a conscious level and train the pt to inhibit the behavior

Redirect attention

Engage pt in tasks that req repetitive action

47

Spatial Neglect Intervention

Provide graded scanning actv

Grade actv from simple to complex

Use anchoring techniques

Utilize manipulative tasks in conjunction with scanning actv

Use external cues (colored markers, written directions)

48

Body Neglect Intervention

Provide bilateral actv

Guide the affected side thru the actv

Increase sensory stimulation to the affected side

49

Aphasia Intervention

Decrease external auditory stimuli

Give increased response time

Use visual cues and gestures

Use concise sentences

Investigate the use of augmentative communication devices

50

Sequencing/Organizing Deficit Intervention

Use external cues (written directions, daily planners)

Grade tasks that are increasingly complex in terms of # of steps req

51

Spatial Relations Dysfunction Intervention

Utilize actv that challenge underlying spatial skills (orienting clothing to body during dressing, wrapping a gift, making a bed)

Utilize tasks that req discrimination of right/left (dress right arm first, plates in left cabinet)

52

Memory Loss Intervention

Use rehearsal strategies

Chunk info

Utilize memory aids

Utilize temporary tags focusing on when the event to be remembered occurred

53

Increased LE edema and pain CVA pt

may indicate a cardiovascular complication, such as deep vein thrombosis, which requires immediate attention from the nurse.
Any intervention should be discontinued.